Bottom Lines

Genotype Test: Should You or Shouldn't You?

A genotype test is a genetic test of your virus to see if it has any mutations. Certain mutations may make HIV medications less effective. Usually, this type of test is not done on patients who are about to start taking HIV medications for the first time. However, it may be a good idea to do so. Initial (also known as "first-line") treatment is very important because it has the best chance of suppressing HIV for a longer period of time than later treatment combinations. A recent study in The Journal of Infectious Diseases (189, p. 2174, 2004) reports that over 8% of HIV-positive patients who have never taken HIV medications already have some mutations. The rate jumps to 15% for patients whose partners are already taking HIV medications. As a result, a patient's first-line regimen may not work and may jeopardize future treatment options.

Another reason to do genotypic testing before starting HIV treatment is to detect any secondary, or minor, mutations. Another study in The Journal of Infectious Diseases (189, p. 1983, 2004) examined 93 HIV-positive patients who, at the start of the study, had never been treated with HIV medications but later experienced virologic failure. They found that patients who had secondary mutations were more likely to develop primary, or serious, mutations. These primary mutations cause HIV medications to fail.

Bottom Line: Ask your healthcare provider about possibly having a genotype test if you have not been treated with HIV medications yet. Also, practice safer sex even if you are in a stable relationship with another positive person. An HIV-positive partner could infect you with a mutated virus, making your HIV harder to treat. Of course, if you are already being treated with HIV medications, a genotype test may be beneficial when considering a change in therapy (especially if viral load has increased, indicating the development of viral mutations).

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Making the Write Choices

The impact of emotional stress and depression on the HIV-positive patient is well established. In fact, a report in the American Journal of Public Health (94, p. 1133, 2004) found that AIDS-related deaths were increased in HIV-positive women with chronic depression compared with HIV-positive women experiencing little or no depression. According to a study published in the journal Pediatrics (113:6, p. e544, 2004), HIV-positive children are also at greater risk of suffering from serious emotional and behavioral problems. Children with HIV or AIDS are more than 3 times as likely to be hospitalized for psychiatric reasons (for example, depression, behavioral problems, talk of suicide, or attempted suicide) compared with HIV-negative children.

An interesting study published in the journal Psychosomatic Medicine (66, p. 272, 2004) may provide some hope to those suffering from stress or depression. Writing about personal and emotional issues has been shown to help many patients with a variety of illnesses, but this practice has never been studied in HIV-positive patients. Thirty-seven HIV-positive adults were randomly assigned (by chance, like flipping a coin) to one of 2 groups and were asked to write for 30 minutes each day for just 4 days in a row. One group wrote about the most traumatic and emotional experiences of their lives, particularly topics they hadn't discussed with anyone before. The other group wrote about unemotional topics including what they had done the day before, and what they had planned for the next day, the next week and the next year. In those patients who wrote about emotional experiences, HIV viral load dropped immediately after the writing period, and then increased gradually over the next 6 months, while T-cell counts gradually and continuously increased during the next 6 months.

Bottom Line: If you or your HIV-positive child is feeling depressed or upset, discuss your concerns with your healthcare provider. While depression and other emotional problems can affect HIV-positive children and adults, there are ways to treat them through counseling and/or medication. Relaxing activities such as writing, drawing or painting, meditating, or praying can help reduce stress and produce beneficial health effects.

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